2014-05-14T09:41:37-05:00 2013-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2012-07-01 440546292 St Joseph Medical Center STJO 8169424400 1000 Carondelet Drive Kansas City MO 64114 Steve Cleary 8169424400 2014-05-13 1 Rebecca Lyons P01487105 5137847100 2012 2015-11-30 17:44:51Z Steve Cleary 1000 Carondelet Drive Kansas City MO 64114 168718975 0 0928 X www.carondelethealth.org X 1874 MO Provides quality medical care regardless of race, creed, sex, origin, handicap, or ability to pay. 5 2 1443 685 0 0 161200 108185 186569862 160981337 2617961 3029745 2897296 4148979 192246319 168268246 25527 18310 0 0 63221386 59967045 0 0 0 115860193 102895730 179107106 162881085 13139213 5387161 149644583 126760672 23664444 2193231 125980139 124567441 X St. Joseph Medical Center is a Catholic organization dedicated to the healing ministry of Jesus Christ. Our commitment to human dignity compels us to provide compassionate, quality health care for the body, mind and spirit, with a special concern for the poor. We are responsible stewards serving the needs of all people from conception to death. At St. Joseph Medical Center we are committed to providing our patients with the best care possible, in a safe and compassionate environment. 0 0 26285198 22751440 Medical inpatient services encompass 3,407 inpatient admissions and 16,651 patient days. St. Joseph Medical Center provides diagnostic services and high quality care to patients admitted with a wide range of diagnoses. Services include radiology disciplines such as MRI, CT-Scans, Ultrasound as well as laboratory tests, respiratory procedures, therapy treatments, pharmacy services, and bedside nursing care. 30087605 31535324 Cardiology services include 1,755 inpatient admissions, 7,366 inpatient days and 3,772 outpatient visits. The Carondelet Heart Institute is a "hospital within a hospital" at St. Joseph Medical Center, focusing on cardiovascular services. Our team of interventional specialists provides treatment for patients diagnosed with conditions such as angina, cardiomyopathy, coronary artery disease, heart attack, peripheral disease, and etc. A full range of tests (such as angiography, echocardiography, carotid doppler, stress echocardiography, and EKG's) are employed to make accurate diagnoses. Carondelet Heart Institute's team of highly trained specialists are well-qualified to perform a range of interventional services such as carotid stenting, coronary angioplasty, coronary stenting, and open heart surgery, that address cardiac and vascular challenges. St. Joseph Medical Center is also involved in preventive services for cardiovascular disease with participation in the Go Red for Women national campaign to raise awareness about heart disease in women. Cardiac rehabilitation at the Carondelet Heart Institute is an exercise and education program, especially designed to help heart patients reduce or control cardiac risk factors, improve cardiovascular fitness and actually learn to thrive with heart disease. The Personal Heart Advocate is a specially trained cardiovascular registered nurse who is dedicated to the patient's individual needs and will assist them through the sometimes complex maze of testing and inpatient procedures. 40301462 40687592 Surgical services include 1,766 inpatient admissions, 10,228 patient days and 3,210 outpatient surgeries. St. Joseph Medical Center offers a wide range of both invasive and non-invasive surgical procedures and is equipped with the latest diagnostic and surgical equipment operated by our highly qualified nursing staff and physicians. Our Medical Center embraces every major discipline of care ranging from minimally invasive procedures to complex multi-disciplinary surgical interventions. We offer a wide range of outpatient and inpatient surgical interventions including open heart surgery, vascular surgery, surgical management of breast disease, surgical oncology, neurosurgery, orthopedic surgery, gynecological surgery, ENT procedures and ophthalmology procedures. 30703930 18310 66746997 All other program services include: Neurology, Oncology, Rehab services, Women's Services, Emergency Room, Radiology, Sleep Lab, GI Lab, Pain Center and other outpatient areas. These services represent 3,074 inpatient admissions with 12,266 patient days, 27,422 emergency department visits and 40,375 other outpatient visits. 30703930 18310 66746997 127378195 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 306 0 1 1443 1 0 0 0 0 0 0 0 0 0 0 X 5 2 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Steve Cleary 8169424400 1000 Carondelet Drive Kansas City MO 64114 X Fleury Yelvington 2.00 46.00 X X 0 1385193 54882 Michael Dorsey 2.00 43.00 X X 0 409055 43677 Steve Cleary 2.00 46.00 X X 0 331260 56260 Spencer Kerly MD Ex-Officio 2.00 0.00 X 0 0 0 Thomas Millard MD Ex-officio 2.00 0.00 X 0 0 0 Vicki Elmore 2.00 2.00 X 0 0 0 Alan Greenwood 40.00 0.00 X 199070 0 36609 Debra Ohnoutka 40.00 0.00 X 192957 0 45012 Thomas Gialde 40.00 0.00 X 147336 0 46525 John Hally 40.00 0.00 X 133048 0 52219 Carol Tiani 40.00 0.00 X 117817 0 43768 Scott Kashman end 711 0.00 0.00 X 0 145802 0 Carla Brogdon end 512 0.00 0.00 X 0 32058 7554 790228 2303368 386506 17 1 1 0 TriMedx LLC 6325 Digital Way Ste 400 Indianapolis IN 46278 Bio-Med Services 4376819 Physician Reference Lab LLC PO Box 802262 Kansas City MO 64180 Lab Services 3322327 Excel Constructors Inc 8041 W 47th Street Overland Park KS 66203 Construction Services (Sch O) 2831641 Sheridan Healthcare of MO Inc 1613 N Harrison Pkwy Bldg C 200 Sunrise FL 33323 Physician Services 1656133 Aramark Healthcare Support Services Inc PO Box 651009 Charlotte NC 28265 Food Services 1650840 23 108185 108185 Net Patient Revenue 621990 160981337 160981337 160981337 3031613 3031613 286614 274753 11861 11861 11861 800 2668 -1868 -1868 -1868 295177 173308 121869 121869 Medicare Incentive 900099 2392619 2392619 Life Flight 621990 484853 484853 Plant Services Revenue 900099 397761 397761 740016 740016 4015249 168268246 161721353 0 6438708 18310 18310 50031917 45084247 4947670 1054616 951275 103341 5272834 4756155 516679 3607678 3271554 336124 1200 1200 13349 13349 15069251 14439911 629340 30403 29274 1129 34708077 33974135 733942 111336 111336 5248119 4184092 1064027 90794 87156 3638 8872 1043 7829 1630632 1263903 366729 6192385 4996307 1196078 1012296 1012296 Corporate Allocation 24783995 412316 24371679 0 MO State Assessment Fee 11564517 11564517 0 0 Purchase Services 1102318 542182 560136 0 Legal Settlement 650000 0 650000 0 678186 678186 162881085 127378195 35502890 0 4731044 1323803 20965430 17981654 3304651 3590419 1503488 1544787 121240171 55933578 65152506 65306593 3223872 3601936 174234 309124 50589358 33102356 149644583 126760672 23664444 2193231 23664444 2193231 X 125848028 124463692 132111 103749 125980139 124567441 149644583 126760672 X 5387161 -6799859 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 13349 13349 0 Explanation of Lobbying Activities: Part II-B, Line 1: Lobbying expenses represent the portion of dues paid to national and state hospital associations that are specifically allocable to lobbying. St. Joseph Medical Center does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 1931137 1931137 73350118 28841410 44508708 45317640 26494349 18823291 641276 597819 43457 65306593 Gift Shop and Other Assets 4536 Intercompany Debt with Ascension Health Alliance 7065376 Interest in Investments Held by Ascension Health Alliance 26032444 33102356 Self Insurance Liability 1094746 Valuation Allowance 1000000 Other Non-Current 97305 Other Liabilities 1180 2193231 1 1 1 X 1 X 1 1 1 0 1 1 3486171 3486171 0.02140 21901202 18601096 3300106 0.02030 0.00000 25387373 18601096 6786277 0.04170 22 2508 412359 41165 371194 0.00230 0.00000 4 2735 5034680 4192341 842339 0.00520 0.00000 54 264180 0 264180 0.00160 80 5243 5711219 4233506 1477713 0.00910 80 5243 31098592 22834602 8263990 0.05080 119 119 0.00000 238 238 0.00000 3384 3384 0.00000 3741 3741 0 15916905 0 70641321 83995877 -13354556 X 1 1 1 1 St Joseph Medical Center

1000 Carondelet Drive Kansas City MO 64114

www.carondelethealth.org X X X St Joseph Medical Center 1 1 X X X X X X X X X 12 1 0 1 X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X 1 1 X X X 1 0 1 X 0 0 Part I, Line 6a: The annual community benefit report is completed for Carondelet Health, the parent organization for St. Joseph Medical Center. Part I, Line 7: The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data, and is calculated in compliance with the Catholic Health Association ("CHA") guidelines. The organization uses a costing accounting system that addresses all patient segments (for example: inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For the information in the table, a cost-to-charge ratio was calculated and applied. Part I, Line 7g: St. Joseph Medical Center provides several clinical services that result in a financial loss. These services include Nursery Intensive Care Unit (NICU), Cardiac Rehab, Senior Clinic and the Obstetric/Newborn program. These services are hospital programs and do not include physician clinic services. Part II: St. Joseph Medical Center provided the following community building activities in fiscal year 2013:- Improved access to health care by particpating in Operation Walk USA, offering free surgical services for orthopedic procedures to individuals without healthcare.- Participated in efforts to improve public health with representation on the KC Metro Healthcare Council, South Kansas City Chamber of Commerce, Kansas City Healthcare Council, American Hospital Association. Part III, Line 4: From the consolidated audited financial statements of Ascension Health Alliance (which includes the activity of St. Joseph Medical Center):The provision for doubtful accounts is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by the System. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies. Part III, Line 8: Ascension Health and related health ministries follow the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit Part III, Line 9b: The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply. St. Joseph Medical Center Part V, Section B, Line 3: Interviews with key stakeholders within Jackson County, MO were conducted between January and February 2013. Attachment A of CHNA lists the names, titles and organizations of those participating in the 30-minute interviews. In total, 50 interviews were completed. Physicians from the St. Joseph Medical Executive Committee and members of the St. Joseph Patient Advisory Committee also participated in this research by providing feedback on the consumer health needs in Jackson County. The individuals who participated in the community stakeholder's interviews represent the broad interests of the community served by St. Joseph Medical Center and included members of organizations serving low-income, minority populations and populations with chronic disease needs. Representatives from the three public health departments serving Jackson County, MO were also included in this research. These community leaders assisted our hospital in ranking the health needs that were determined to be a priority in the community. For a full list of organizations represented by the community stakeholders, reference Appendix A of CHNA. For a copy of the key stakeholder interview guide, including a ranking worksheet of top priorities in Jackson County, MO, reference Appendix B of CHNA. St. Joseph Medical Center Part V, Section B, Line 7: Needs Not being Addressed as Priority: - Access to Quality Healthcare: This need will not be addressed as priority. SJMC has a 24-hour Emergency Care Department that sees all patients seeking emergent care. SJMC has a charity care policy and makes every effort to assist our patients with their financial challenges after treatment. We provide counselors to assist qualified patients the opportunity to enroll in Missouri Medicaid. We have partners in the community that also provide services to assist with access to care. - Addiction/Substance Abuse: This need will not be addressed as a priority by SJMC. Although we treat patients suffering from addictions with their acute symptoms, we utilize services in the community that are specifically designed for this issue. - Maternal, Infant, and Child Health: This need will not be addressed as a priority by SJMC. We currently provide obstetrical services at the hospital and have had a program specifically designed to assist new parents with education and resources. This program is called Healthy Beginnings and helps young, first-time mothers with understanding their pregnancy and provides them a car seat and other supplies upon completion of the program. - Mental Health and Mental Disorders: This need will not be addressed as a priority by SJMC. SJMC does not have the capacity to provide in- or out-patient psychiatric care. We utilize our partnerships in the community to address these issues. - Tobacco Use: This need will not be addressed as a priority by SJMC. SJMC provides smoking cessation classes and partners with other community agencies for education. SJMC supported the efforts of the Missouri Hospital Association with the state legislature to increase the sales tax on tobacco products. - Violence Prevention: This need will not be addressed as a priority by SJMC. SJMC is involved with the patients or employees involved in domestic violence, particularly as these incidents spill over into care issues in the institution. St. Joseph Medical Center Part V, Section B, Line 20d: For cases that apply for our charity care program, upon receipt of a completed application, collection activity will cease until a determination has been made. For presumptive charity cases (cases where an application is not necessarily completed), collection activity may continue while the due diligence is being completed or until the patient's account is reviewed. Additionally, for all patients identified as full charity care patients, Carondelet Health:- Will not place a lien on a charity care patient's primary residence or include the primary residence in the asset calculation unless the value of the property clearly indicates an ability to assume the financial obligation and subject to senior management approval.- Will not execute a lien or force the sale or foreclosure of a charity care patient's primary residence/property to pay for an outstanding medical bill.- Will not use forced court appearance to require the charity care patient or responsible party to appear in court.- Will not garnish wages.Hospital charity policy has a yearly maximum to be charged for medical care for catastrophic medical cases where patient/guarantor medical bills exceed 20% of their gross income plus assets for the year.Uninsured Patient Discount Eligibility Criteria: An uninsured patient who does not qualify as financially or medically indigent shall receive a discount. Effective 7/1/10, the uninsured discount will be 30%.Prompt Pay: Prompt payment discounts are extended to all self-pay balances in return for immediate payment of patient/guarantor's. The prompt pay discount provides patients with balances due an alternative method of payment, as well as expedites the resolution of self-pay receivables. A prompt pay discount of 10% of charges is applicable for patients who meet the terms as stated in Carondelet Health Business Office Discretionary Discount Policy. Part VI, Line 2: The health care needs of our community are assessed every year by the Mid-America Regional Council. The assessment is based on data collected through surveys of safety net clinics and information provided by the Missouri and Kansas Hospital Associations and public health records. A committee comprised of representatives from many areas of the Medical Center was created to develop recommendations to improve access to health care in the community. Last fall, Carondelet Health implemented a new process that will comply with the Patient Protection and Affordable Care Act of 2010 requirement for a community health needs assessment including both qualitative and quantitative research. Part VI, Line 3: For uninsured patients, at time of service, we interview the patient looking for "found" insurance (Medicaid, Cobra, automobile insurance or local government programs). If no insurance coverage is discovered, we discuss payment arrangements and the hospital's financial assistance/charity programs. After time of service, when patients contact the business office regarding their patient care liability and the patients indicate a financial hardship in making payment, we discuss payment arrangements and the hospital's financial assistance/charity program. Part VI, Line 4: Carondelet Health is comprised of two acute care hospitals, St. Joseph Medical Center and St. Mary's Medical Center, along with Carondelet Home Care Services, a home health agency. Carondelet Health primarily serves the southern and eastern areas of metropolitan Kansas City, which comprise approximately two-thirds of the entire Kansas City population of 2.3 million people. 13.8 percent of households live at or below federal poverty guidelines, and uninsured and underinsured persons represent 25 percent of the population. 42.4 percent of the population are minority and 7 percent speak a language other than English, predominantly Spanish. Part VI, Line 5: Carondelet Health's board is comprised of individuals from throughout the community. Medical staff privileges are extended to all physicians who apply and meet qualifications. Carondelet Health provides a wide variety of resources to help improve the health of the community. Our Web site provides a free comprehensive health library with information on general wellness and specific health conditions, along with additional direct links to other health care support organizations. Meeting space is offered on the campuses of St. Joseph and St. Mary's Medical Centers for use by community groups. A wide range of support groups provide counseling for patients and their families coping with health concerns. In addition, Carondelet Health's community outreach efforts provide health and wellness resources that otherwise may be unavailable to many community members, including free health screenings and health educational materials. Part VI, Line 6: Carondelet Health is a member of Ascension Health.Ascension Health Alliance is a Missouri nonprofit corporation formed on September 13, 2011. Ascension Health Alliance is the sole corporate member and parent organization of Ascension Health, a Catholic national health system consisting primarily of nonprofit corporations that own and operate local healthcare facilities, or Health Ministries, located in 23 of the United States and the District of Columbia.SponsorshipAscension Health Alliance is sponsored by Ascension Health Ministries, a Public Juridic Person. The Participating Entities of Ascension Health Ministries are the Daughters of Charity of St. Vincent de Paul in the United States, St. Louise Province; the Congregation of St. Joseph; the Congregation of the Sisters of St. Joseph of Carondelet; the Congregation of Alexian Brothers of the Immaculate Conception Province, Inc. - American Province; and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi - US/Caribbean Province. As more fully described in the Organizational Changes note, Marian Health System, which was previously sponsored by the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi - US/Caribbean Province, became part of Ascension Health on April 1, 2013. In addition, Alexian Brothers Health System, which was previously sponsored by the Congregation of Alexian Brothers of the Immaculate Conception Province, Inc. - American Province, became part of Ascension Health on January 1, 2012.MissionThe System directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing, and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it serves. In accordance with the System's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. The System uses four categories to identify the resources utilized for the care of persons living inpoverty and community benefit programs: - Traditional charity care includes the cost of services provided to persons who cannot afford healthcare because of inadequate resources and/or who are uninsured or underinsured.- Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for persons living in poverty and other vulnerable persons.- Cost of other programs for persons living in poverty and other vulnerable persons includes unreimbursed costs of programs intentionally designed to serve the persons living in poverty and other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with acquired immune deficiency syndrome.- Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the persons living in poverty, including health promotion and education, health clinics and screenings, and medical research.Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons living in poverty and community benefit programs. The cost of providing care to persons living in poverty andcommunity benefit programs is estimated by reducing charges forgone by a factor derived from the ratio of each entity's total operating expenses to the entity's billed charges for patient care.Community Benefit ReportCarondelet HealthFor the year ended June 30, 2013From humble beginnings in a three-story house in downtown Kansas City, the sisters of St. Joseph of Carondelet brought compassionate care to the most humble among us. Care that connects the body, mind and spirit, with a special concern for the poor.That special concern comes in the form of new technology and caring hands that guide today's medicine to the good of all. It comes also in the form of financial assistance to uninsured patients at both St. Joseph and St. Mary's Medical Centers, regardless of their employment or credit history. Whether our patients need help applying for Medicaid assistance, or extended time to settle their bills with interest-free, extended-term payment plans, Carondelet Health will be that helping hand. We believe caring for our communities means caring for those who are sick and those who are underserved. We also believe it is our responsibility to promote wellness in those we serve.Our MissionCarondelet Health consists of Catholic organizations dedicated to the healing ministry of Jesus Christ. Our commitment to human dignity compels us to provide compassionate, quality health care for body, mind and spirit, with a special concern for the poor. We are responsible stewards serving the needs of all people from conception to death. We are united in this mission.Upholding the commitment of our founding Sisters of St. Joseph of Carondelet and the Sisters of St. Mary, we turn away no one in need. Compassionate, quality care remains the standard at all our facilities.Involvement with Community EventsBeyond free blood pressure, blood sugar and prostate cancer screenings, St. Joseph and St. Mary's participate in numerous health fairs, including the annual Fall Family Health Celebration at St. Joseph and St. Mary's annual Wellness Fair, traditionally opening Eastern Jackson County Family Week activities. Together the medical centers sponsor a domestic violence rally to raise awareness and support area victims. St. Joseph also coordinates a free informational seminar with the American Diabetes Association. Contributions to Community Groups. Carondelet Health contributes to many worthwhile organizations, including Cristo Rey High School, the American Cancer Society, the American Heart Association and Catholic Charities of Kansas City. It supports the Seton Center Family and Health Services by providing human resources, maintenance and wellness services; and funds after school programs for at-risk children at YMCAs in Kansas City and Blue Springs. CarondeletHealth.org offers the latest in health information and direct links to more than 50 health-related organizations and support groups.Caring for Our CommunityCompassion goes beyond those financially challenged. It encompasses those who are vulnerable due to age and circumstance. Carondelet Health's facilities actively commit its resources to the communities they serve, through a wide variety of programs and services for the physical, mental, social and spiritual care of area residents:Healthy BeginningsThe St. Joseph Medical Center Foundation, with the support of local community agencies, make it possible to offer a unique prenatal program free of charge for patients who are on Medicaid, teens, or for others socially at risk, that could benefit from additional support. Members of this group receive three to five individual visits with a RN for one-on-one education. Participants also receive a free car seat, childbirth and breast feeding classes, a breast pump and much more. St. Joseph's Seniors Clinic addresses health needs of homebound seniors and residents of long-term care and assisted living facilities. The clinic provides a comfortable, convenient, cost-effective setting where seniors' needs can be assessed, diagnosed and treated by physicians. The clinic also provides free transportation for many patients. Seniors can now also take health assessments online and receive information on coping with:- Sleep Disorders- Emotional Health- Cognitive Health - Nutritional Health- Urinary Incontinence- Skin Issues - Fall RiskSupport GroupsBoth medical centers offer groups for Alzheimer's, battered women, bereavement, breast cancer survivors, diabetes, Lyme disease, stroke and other areas of need.Classroom SpaceSpace is provided for alternative high school classes offered by the Kansas City School District. Other not-for-profit agencies are welcomed to host meetings and seminars in the medical centers for a nominal fee.Caring for the PoorCharitable Losses by Carondelet Health of Kansas City Fiscal Year 2013 (July 1, 2012-June 30, 2013) Unpaid Medicaid: $6.1 millionUnpaid Medicare: $26.1 millionTraditional Charity: $5.9 millionCommunity Services: $3.2 millionTotal: $41.3 million Reports Filed With States Part VI, Line 7 MO 1 0 0 Scholarships 33 18310 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: A committee determines scholarship dispersal based on application and interviews. 1 1 1 0 0 0 0 0 0 0 Fleury Yelvington 0 500922 0 768420 0 115851 0 41549 0 13333 0 1440075 0 0 Michael Dorsey 0 325308 0 37089 0 46658 0 22500 0 21177 0 452732 0 0 Steve Cleary 0 263746 0 31651 0 35863 0 43822 0 12438 0 387520 0 0 Alan Greenwood 194584 0 3400 0 1086 0 16501 0 20108 0 235679 0 0 0 Debra Ohnoutka 176828 0 15000 0 1129 0 31582 0 13430 0 237969 0 0 0 Thomas Gialde 139307 0 770 0 7259 0 32323 0 14202 0 193861 0 0 0 John Hally 126509 0 1125 0 5414 0 42810 0 9409 0 185267 0 0 0 Carol Tiani 117479 0 0 0 338 0 33816 0 9952 0 161585 0 0 0 Scott Kashman end 711 0 0 0 0 0 145802 0 0 0 0 0 145802 0 0 Carla Brogdon end 512 0 23454 0 0 0 8604 0 0 0 7554 0 39612 0 0 Part I, Line 3 Carondelet Health, a related organization of St. Mary's Medical Center, uses the following to establish the compensation of the organization's CEO (Michael Dorsey): - Compensation Committee - Independent Compensation Consultant - Written Employment Contract - Form 990 of Other Organizations - Compensation Survey or Study - Approval by the Board or Compensation Committee. Supplemental Information Part III Part I, Line 4a: Severance Payments - Scott Kashman - $129,078 Supplemental Information Part III Part I, Line 4b: Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. A related organization that paid the salaries of the individuals listed in Schedule J, Part II, contributed to the supplemental nonqualified retirement plan in the amount as noted: - Steve Cleary - $31,651 - Fleury Yelvington - $76,825 - Michael Dorsey - $37,089 A related organization that paid the salaries of the individuals listed in Schedule J, Part II, paid out of the supplemental nonqualified retirement plan in the amount as noted: - Scott Kashman - $16,724 Supplemental Information Part III Part I, Line 6: Compensation was accrued contingent on meeting an overall operating margin of a related organization as this was a measurement included within a Short Term Incentive program for system leaders. Form 990, Part VI, Section A, line 2 Many of the persons listed on Part VII have a "business relationship" with each other by virtue of sitting on related Carondelet Health entity boards. Form 990, Part VI, Section A, line 6 St. Joseph Medical Center has a single corporate member, Carondelet Health. Form 990, Part VI, Section A, line 7a St. Joseph Medical Center has a single corporate member, Carondelet Health, who has the ability to elect members to the governing body of St. Joseph Medical Center. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to St. Joseph Medical Center financial information or corporation as a whole are subject to approval by its sole corporate member, Carondelet Health. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members questions. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee meeting will decide if conflict of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflict of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Section B, line 15 In determining compensation of the organization's CEO (Michael Dorsey), the process performed by Carondelet Health (a related organization) included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Audit Committee reviewed and approved the compensation. In the review of the compensation, the CEO was compared to other organizations in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. Individual was not present when his compensation was decided. In determining compensation of other officers of the organization, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Audit Committee reviewed and approved the compensation. In the review of the compensation, the other officers of the organization were compared to other organization's officers in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. Individuals were not present when their compensation was decided. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Form 990, Part VII, Section B: The payments reported on Form 990, Part VII, Section B from Excel Constructors represents payments for both good and services. These amounts cannot be separated. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfer to Affiliates -6,293,420. Transfer to Sponsor -350,000. Restricted Contributions Used for Property 440,512. Transfer of Funds -620,045. Transfer from Related Organizations 23,094. Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health system MO Section 501(c)(3) Schedule A, Line 11a Ascension Health Alliance 0 Carondelet Health 1000 Carondelet Drive Kansas City MO 641144673 431276738 System Parent MO Section 501(c)(3) Schedule A, Line 11c Ascension Health 0 Carondelet Health Corp & Affil Emp Health & Dental Care 1000 Carondelet Drive Kansas City MO 641144673 431116849 VEBA MO Section 501(c)(9) N/A Carondelet Health 1 Carondelet Home Care Services Inc 11050 Roe Suite 120 Overland Park MO 66211 431379352 Home Health Care Services MO Section 501(c)(3) Schedule A, Line 3 Carondelet Health 1 Carondelet Cardiology Services Inc 1000 Carondelet Drive Kansas City MO 641144673 271322670 Health Care MO Section 501(c)(3) Schedule A, Line 9 Carondelet Health 1 St Mary's Medical Center 201 West RD Mize Rd Blue Springs MO 64014 431284526 Health Care MO Section 501(c)(3) Schedule A, Line 3 Carondelet Health 1 St Mary's Medical Center Foundation 1000 Carondelet Drive Kansas City MO 641144673 431918107 Fundraising MO Section 501(c)(3) Schedule A, Line 11c Carondelet Health 1 St Joseph Medical Center Foundation 1000 Carondelet Drive Kansas City MO 641144673 431388461 Fundraising MO Section 501(c)(3) Schedule A, Line 11c Carondelet Health 1 South Kansas City Surgical Center LLC 10730 Nall Ste 100 Overland Park KS 66211 202181884 Health Care KS N/A Indian Creek Center Inc 1000 Carondelet Drive Kansas City MO 641144673 480956627 Management MO N/A C 0 Carondelet Management Company Inc 11050 Roe Suite 110 Overland Park KS 66211 431352545 Health Management KS N/A C 0 Carondelet Pharmacy 1000 Carondelet Drive Kansas City MO 641144673 431699329 Pharmacy MO N/A C 0 Carondelet Primary Care Network Inc 1000 Carondelet Drive Kansas City MO 641144673 431596702 Health Care MO N/A C 0 Saint Joseph Ambulatory Surgical Center LLC 1000 Carondelet Drive Kansas City MO 641144673 251905706 Health Care MO N/A C 0 Carondelet Occupational Hlth Wellness & Edu Svcs Inc 1000 Carondelet Drive Kansas City MO 641144673 861144194 Health Care MO N/A C 0 Carondelet Physician Services 1000 Carondelet Drive Kansas City MO 641144673 562661163 Health Care MO N/A C 0 Carondelet Medical Enterprises 1000 Carondelet Drive Kansas City MO 641144673 562661165 Office Admin. Services MO N/A C 0 0 1 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 St Joseph Medical Center Foundation C 545018 Journal Entry Carondelet Health K 443248 Journal Entry Carondelet Health O 8795161 Journal Entry Carondelet Health P 12089542 Journal Entry Carondelet Home Care Services Inc P 956651 Journal Entry Carondelet Pharmacy P 389639 Journal Entry Carondelet Physician Services P 2421890 Journal Entry Carondelet Medical Enterprise P 3737221 Journal Entry Carondelet Cardiology Services Inc P 7921895 Journal Entry Carondelet Occupational Health Wellness & Educational Services Inc P 1347580 Journal Entry St Mary's Medical Center P 16159351 Journal Entry Indian Creek Center Inc P 210255 Journal Entry Carondelet Health Q 16577957 Journal Entry Carondelet Health Corp & Affil Employee Health and Dental Care R 6858830 Journal Entry Carondelet Health R 12021928 Journal Entry Carondelet Cardiology Services Inc R 565000 Journal Entry Carondelet Medical Enterprise R 1860000 Journal Entry St Joseph Medical Center Foundation S 260482 Journal Entry St Mary's Medical Center Foundation S 134906 Journal Entry Carondelet Occupational Health Wellness & Educational Services Inc S 367942 Journal Entry